How people-centred is South Africa’s mental health system? An integrative review of research from 2011 to 2024

Aim This paper presents a current review of South Africa’s mental healthcare research and system progress, by: (1) mapping out the type, scope and focus of research studies that have been undertaken, and (2) drawing conclusions from those studies on the progress made towards reforms in developing a people-centred mental health system. Method An integrative review with thematic analysis guided by the World Health Organization Framework on Integrated, People-centred Health Services was employed. Results A total of 126 papers over a period of 13 years were included for final analysis. A relatively large proportion of papers used qualitative methodologies, followed by secondary document analysis, the majority of papers being descriptive. Most papers focused on all mental health conditions, followed by common mental conditions such as depression, anxiety and substance use disorder. While progress emerged in the reorientation of the model of care, and in co-ordinating services, substantial gaps remain in terms of strengthening governance and accountability, as well as in empowering and engaging people. Creating an enabling environment was exemplified by the introduction of two cycles of the National Mental Health Policy Framework and Strategic Plan, although implementation of the policy remains suboptimal. Conclusion The review mirrors findings from an earlier review, and key barriers remain in terms of insufficient resources and governance structures to adequately support community-based, people-centred services, the under-detection of common mental conditions, limited culturally congruent services, stigma, and a lack of intersectoral collaboration.